Penn Urogynecology.........................................................................

WHAT IS OVERACTIVE BLADDER (OAB)?

Overactive bladder is very common! Most people with overactive bladder say, "I cannot get to thebathroom quick enough', or "I have an accident on the way to the bathroom'. Overactive bladder: isnot 'your fault'!!!

In overactive bladder, the nerves that connect the bladder to the brain have become too sensitive.The nerves get stimulated even if there is only a little urine in the bladder. The nerves make t~ebladder have a 'spasm'. You feel the spasm as an intense urge to go to the bathroom. But if tilespasm is strong, you will leak urine on the way to the bathroom. The goal of treatment is to 'calm'the nerves that supply the bladder .

OVERACTIVE BLADDER (OAB) - TREATMENT

1. Diet and Fluids

What you eat and drink does not cause overactive bladder. But if you already have overactivebladder, the amount and type of your fluid intake can aggravate your symptoms. "8 glass~sof water a day" is a myth. Drink to thirst. Reduce your intake of coffee, tea, especially iced teaand soda to a minimum. The best way to get your fluids is from eating real fruits andvegetables (not fruit juice). Constipation and weight gain can make symptoms of overactivebladder worse. Eating lots of vegetables will prevent constipation and help you lose weight

2. Kegel Exercises

·Pelvic floor exercises can reduce bladder symptoms by calming the nerves of the bladder.You can do Kegel exercises anywhere and at anytime. To locate your pelvic floor muscles,imagine trying to stop the flow of urine or imagine you're trying to keep from passing g~s.When you've located the correct muscles, squeeze them and hold to a count of 3. Do a set.of10 squeezes 3 times every day. "Quick flicks" help to control sudden urges. For maximumadvantage, consider working on these- exercises with a physical therapist or a nurse. .

3. Medications

·Medications work on 'receptors' on the bladder and help to calm the nerves that supply thebladder. These medicines help to increase "warning time" to urinate. .

·The 'receptors' for these medicines are also present in the mouth and the bowels. So sideeffects include dry mouth and constipation. If you eat lots of fruits and vegetables, both theseside effects will be minimal. Blueberries, strawberries, oranges, apples and grapes, and prunesare particularly good because they stimulate saliva and treat constipation. Rinse your mouthfrequently; try over-the-counter Biotene mouth wash or an over-the-counter stool softener e;g.Senakot-S. .

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4. Sacral Nerve Stimulation (Bladder Pacemaker)

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5. Botox

When treatments described above are not working,your doctor may recommend a bladder pacemaker.A bladder pacemaker is very simllar to a heartpacemaker. A heart pacemaker regulates the nervesof the heart. A bladder pacemaker regulates thenerves of the bladder.

The bladder pacemaker is a small temporary battery(3 cm) that is placed under the skin of your buttock.A fine lead (as thin as a hair) makes contact with thenerves that supply your bladder and calms themdown. A bladder pacemaker is placed under localanesthesia and has been used for over 10 years.Because the battery is expensive, we will first testand make sure that the battery works for yoursymptoms before we place it under your skin. Formore information, go to www.medtronic.com

Botox is another simple treatment option for overactive bladder. The doctor will inject Botoxinto the muscles of the bladder through a cystoscope in the office under local anesthesia. Thetreatment is not covered by insurance companies. Botox calms the nerves that supply thebladder muscles and benefits can last from 6 months to 1 year.

For treatment of Urinary Incontinence, you can contact,

Dr. Lily Arya, Urogynecology at Hospital of University of Pennsylvania 215 622 6035 or atPenn Medicine at Radnor 610 9022500

Dr. Heidi Harvie, Urogynecology at Pennsylvania Hospital: 215 829 2345 or at Chestnut HillHospital 215 248 3100

Dr. Ariana Smith, Urology at Hospital of University of Pennsylvania 215 662 2891, or atPennsylvania Hospital 215 8293409

The University of Pennsylvania is conducting a research study for women who haveoveractive bladder. The study is funded by the National Institutes of Health [NIH]. Thestudy is for women who have bladder accidents caused by urgency but medications,bladder training and Kegel exercises are not working. Subjects will receive eitherbladder pacemaker or Botox injections in the bladder.

Call Michelle Kinglee at 215 615 6569